Journal of Hospice & Palliative Nursing最新文献

The purpose of this pilot posttest-only, randomized, controlled group study was to evaluate if a combination of educational methods (written, video, and/or group discussion) would improve the readiness of older adults to participate in advance care planning (ACP). Participants were 65 years and older, English-speaking, receiving outpatient care, having at least one life-limiting illness, and without an advance directive. An independent t test and 1-way analysis of variance compared responses to 9 survey questions of readiness between the control group and the intervention groups. This pilot study found that educational materials are useful resources to acquaint patients with ACP, but they may be more effective if complemented with other approaches to increase patient awareness and readiness to create an ACP.

Despite mandates requiring hospitals to offer advance directives to all patients, many adults do not have advance directives in place at the end of life. This quality improvement project aimed to implement an evidence-based, standardized protocol to increase advance directive completion rates for hospitalized patients with serious illnesses. A preimplementation and postimplementation design was used to evaluate the impact of an educational intervention and advance directive completion protocol. The project was conducted at a midsized urban community hospital in the Northeastern United States. Charts were reviewed for 250 patients with serious, chronic illnesses admitted under family medicine. Over the 11-month project period, advance directive completion rates increased from 21% (17/82) preintervention to 43% (73/168) postintervention, a statistically significant improvement of 22% ( P = .001). Protocol compliance rates increased from 0% to 50% (8/16) for nurses and from 17% to 31% (9/52 to 21/68) for resident providers. The results support the use of a standardized advance directive completion protocol, combined with educational sessions, to improve advance directive completion rates for seriously ill patients and safeguard their autonomy at the end of life.

Immunotherapies are increasingly used to treat advanced cancers and can extend survival in some patients. The potential for longer survival may inflate prognosis expectations among patients and caregivers and delay palliative care. This review sought to identify issues impacting patients and caregivers that influence specialized palliative care use in the context of immunotherapies. A scoping review was conducted with guidance from the JBI Manual for Evidence Synthesis. Studies were identified using MEDLINE, EMBASE, CINAHL Complete, AgeLine, Cochrane Library, and APA PsycINFO, without any database filters or limiters. Inclusion criteria included palliative care utilization among adult cancer patients receiving immunotherapy and their family caregivers in any geographical or specialty setting. The protocol was registered in the Open Science Framework. Using Covidence, 11 898 studies were screened by reviewers, with 10 studies meeting inclusion criteria. Themes of patient and family considerations that affect the use of specialized palliative care included (1) understanding of disease/treatment, (2) hope/optimism, (3) communication barriers, and (4) emotional distress and uncertainty. This review is one of the first to identify issues impacting patients receiving immunotherapies and their families. Findings have implications for nurse communication, education, and psychosocial support with advanced cancer patients and families receiving immunotherapies.

Pediatric oncology patients should receive high-quality end-of-life care when needed. Little is known about nurses' attitudes toward providing end-of-life care in pediatric oncology and the role of work experience in developing comfort with providing this care. In a sample of nursing students and nurses working in pediatric oncology, this mixed-methods study aimed to describe attitudes toward and experiences of providing end-of-life care and examine the relationship between education, work experience, and attitudes. Participants completed a demographic survey and the Frommelt Attitude Toward Care of the Dying, modified for pediatrics. Qualitative interviews were then completed with 10 participants. Participants (N = 38) were primarily female (87%) and White (89%). Overall, participants held positive attitudes toward end-of-life care, with staff nurses more positive than student nurses. All participants had provided end-of-life care, yet only 2 (5.41%) thought their education thus far prepared them. Age, education, experience, and burnout were associated with attitudes toward providing end-of-life care. Qualitative themes included challenges of preparedness and training, the nurse's role, and parent team barriers. Training in pediatric end-of-life care is crucial to improve nurses' comfort with providing this care. Further research should explore the impact of burnout, compassion fatigue, and interdisciplinary conflict on end-of-life care.

The purpose of this scoping review was to explore and to summarize the published literature on palliative care nurse specialist's perspectives of spiritual care at end of life. The Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews Checklist was followed. Searches were conducted in 6 online databases (PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane, HSELibrary). Following a rigorous review process, 15 studies met the inclusion criteria. Data were extracted using a template analyzing aims, population, mean age, setting, year of study, methodology, and key findings. The findings were organized into 4 categories: communication, education and experience, religion, and nurse-patient relationship. The research demonstrates that specialist palliative care nurses perceive spiritual care as an important element of holistic care at end of life; however, these nurses also agree that spiritual care is lacking. This deficiency results from a lack of education in spirituality; experience of the nurse; the nurses' own spiritual and religious beliefs and values, fears, and difficulties in communication; and the nurse-patient relationship. The findings demonstrate the necessity to increase the level of spiritual care education in nurse programs, educating nurses on the provision of spiritual care, and how to deal with conflicts in spiritual and religious beliefs.

Since the inception of medical assistance in dying (MAiD) in Canada in 2016, the health care system continues to refine MAiD delivery models. The frameworks informing nursing practice related to MAiD are subject to variability across the country, leading to nursing role ambiguity and barriers in relational practice. Using critical incident technique, this qualitative research study explores the experiences of 7 Canadian nurses engaging with patients seeking MAiD. Semistructured interviews were conducted to understand the nurses' perceptions of the helping, hindering, and desired elements of current nursing practice supports within the context of MAiD. Eighteen significant incidents were included in the data analysis. Findings demonstrate that gaps in practice support exist related to nursing role clarity, educational support to enrich therapeutic communication skills, and staff-focused resources, such as debriefing and improved communication networks. Understanding nursing experiences within this context highlights the need for more consistent nursing practice frameworks and clinical practice supports to facilitate improved therapeutic relationships and patient care.

Early integration of palliative care benefits both people with advanced cancer and their family caregivers, yet research on holistic end-of-life care and advance care planning remains limited. The primary objective of this study was to examine the effect of a peaceful end-of-life care program on perceived good death outcomes in people with advanced cancer and their family caregivers. Secondary objectives included exploring the program's effect on the quality relationship and end-of-life care knowledge among family caregivers. In this quasi-experimental design with repeated measures, 122 participants were enrolled. On the basis of the Theory of the Peaceful End of Life, the experimental group received a 4-week program comprising health education, self-care for symptom management, advance care planning, psychosocial support, and family involvement plus standard care, whereas the control group received standard care alone. The Good Death Inventory was the primary measurement tool. The results showed a significant improvement in perceived good death, quality relationships, and end-of-life care knowledge in the experimental group, with no such improvements observed in the control group. The program improved good death outcomes, caregiver relationships, and end-of-life care knowledge. Therefore, early initiation of this program is recommended to optimize its benefits.

Psychedelic-assisted therapy (PAT) involves supported experiences with psychedelic medicines in carefully curated environments. Early evidence suggests possible utility of PAT for addressing psychosocial-spiritual-existential concerns, yet gaps remain in understanding findings related to PAT's role in palliative care. This rapid review aims to synthesize current literature on applications of PAT in the context of palliative care. Through a systematic process, we identified 34 articles published between January 2021 and July 2024. Protocols varied yet included common components of participant screening, preparation, dosing, and integration. Psilocybin was the most commonly studied compound. Results support safety and initial efficacy of PAT for psycho-spiritual-existential outcomes among carefully screened and highly homogonous samples of patients with serious illness (predominantly cancer). Current efforts and challenges around integrating PAT into systems of palliative care were highlighted. Additional work is needed to (1) explore PAT's safety and efficacy within more diverse samples and contexts, (2) train palliative care providers on PAT, (3) determine systems of care delivery best suited for translation of PAT into practice, and (4) begin developing policy solutions to support safe and equitable access to PAT. Because many patients lack access to basic psychosocial-spiritual-existential care, careful consideration is needed around integration of PAT. The psychedelic substances which are the topic of this article are not currently FDA approved for use in the United States.

This study aims to deepen the understanding of rapport formation between nurses and end-of-life patients by synthesizing existing qualitative research. Using meta-ethnography, this research integrates findings from various studies to explore the essence and process of rapport formation from nurses' perspectives. A comprehensive search across MEDLINE, EMBASE, CINAHL, and Web of Science databases in August 2024 identified 13 relevant studies. The quality of these studies was assessed using the Critical Appraisal Skills Programme checklist. The analysis identified 5 key themes in rapport building: "secure acceptance and safety," "genuine and transparent interaction," "insight into the patient's world," "bonding enhanced by professional support," and "advancing connections within boundaries." These themes underscore the role of rapport in enhancing the quality of palliative care, providing emotional stability, and improving the nurse-patient relationship. This study offers valuable insights for health care professionals to strengthen nurse-patient interactions, emphasizing the importance of rapport in end-of-life care.

Communities use rituals at end of life to foster a peaceful death, ensure passage to the afterlife, and grieve their lost loved ones. Studies report fear of misunderstanding or impeding rituals as a barrier to accepting hospice care. However, there has been little research on cultural and spiritual rituals in the setting of hospice care or how patient preference should be assessed, documented, and supported by hospice staff. This project sought to identify the current practice for assessment of cultural or spiritual end-of-life practice preferences, and the documentation of those preferences, within pediatric hospice programs in a Midwestern state. In surveys of 2 pediatric hospice programs, employee respondents reported routine assessment (97.3%) and routine documentation (70.3%) of cultural or spiritual end-of-life practice preferences. Most respondents reported documentation was written by various disciplines and in various locations in the medical record. Additionally, a retrospective chart review was performed including decedents of 1 pediatric hospice program over a 5-year period. Documentation affirming familial spiritual beliefs was identified in 75.9% of charts, of which, only 12.2% had documentation regarding end-of-life-specific spiritual needs. Standardized documentation practices may help foster equitable hospice care for all patients by ensuring care providers are aware of the patient and/or family's end-of-life spiritual needs.